Kevin Knauss: Health, History, Travel, Insurance
In what has become routine for Covered California, they alerted agents to another CalHEERS enrollment website problem late on a Friday afternoon. The latest email notified agents that the system has been calculating the wrong Advance Premium Tax Credit (APTC) on submitted applications. While the Covered California email blast wasn’t real specific, it sounds like the APTC number is wrong when the applicant confirms the health plan purchase, but correct in the “Eligibility Results” page.
Covered California doesn’t have a monopoly on individual and family health plans in California. In addition to the carriers participating in the California exchange, Cigna is also offering health insurance outside of Covered California. Cigna is offering eleven different individual and family plan (IFP) options in California: seven Baseline Portfolio plans and four plans that mirror the Covered California standard metal tier levels for 2014. None of their plans are available through Covered California for the Advanced Premium Tax Credit.
With no website and no functioning customer service, Covered California’s SHOP for small groups has ceased to exist. There may be a glimmer of hope for a return, but it is painfully apparent that SHOP is wrestling above its weight class. Whether their total melt-down is a function of poor vision and management from Covered California executive management and Board is anyone’s guess. That is a moot point when small groups that earnestly wanted to support and participate in the ACA have been handed plate of food contaminated with mold and weevils.
In an effort to dull the impact of the bad news, Covered California released a statement late on a Friday afternoon detailing how many applications were effected by the previous week’s crash of their website. Covered California estimated that 14,500 applications that were started before the CalHEERS enrollment website went dead for five days may have to be resubmitted. Agents and consumers that started applications on February 17, 18, and 19, while the site was functioning but experiencing problems, before it completely crashed on the 20th may need to resubmit or start a whole new health plan application.
The Small Business Health Options Program (SHOP) from Covered California has unfortunately proved itself to be just as inept at processing enrollments as the individual and family plan side. What promised to be a stream lined and easy process for small employer groups to offer health insurance to employees through Covered California is beset with a dysfunctional enrollment website and poorly trained support staff. They make Anthem Blue Cross’ decision not to offer plans through SHOP absolutely prophetic.
With more working Americans eligible for expanded Medicaid health insurance there is also a growing fear that some government agency will want to seize a recipient’s assets to pay for the health care expenses. Fortunately, the expanded Medicaid, Medi-Cal in California, works under slightly different rules and provides some protection against “claw back” of assets to satisfy health care debt. However, one age group may be subject to Medi-Cal estate recovery rules under expanded Medicaid.
What should be a simple task of changing from one Covered California health plan to a new one is proving to be no easy switch. The Covered California CalHEERS internet based program seems incapable of handling the switch between health plans for residents. People are complaining of retroactively cancelled policies, odd effective dates and a system unable to handle simple billing issues.
Covered California is finally scrapping their error filled doctor search feature on their ACA enrollment website. Initially conceived to help match families with health plans that supported their current physicians, it had problems from the start. Covered California announced in a press release they will be taking their provider directory offline until further notice.
Covered California has provided basic statistics and pretty pie charts on enrollment numbers into the ACA health plans that they offer. But what is left out is the statistical data that economists and demographers would like to have to ascertain if the Affordable Care Act is merely working or if it is actually fulfilling the promise to reduce health disparities in our communities with affordable health insurance.
In an attempt to help consumers decide on the right health plan, Covered California has compiled a star rating system for the health insurance carriers based on outdated information. Even worse than basing a report on old data is the disastrous customer service that many Californians have experienced from many of these health insurance companies, including Covered California, in the last two months. The horrible customer service and nightmare enrollment process is not reflected in the new quality rating results.
